Sh Wong

High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

BACKGROUND AND AIMS Celiac disease remains underdiagnosed at endoscopy. We aimed to assess the utility of I-Scan (virtual chromo-endoscopy) to improve sensitivity of endoscopy to detect markers of villous atrophy in this condition. METHODS Patients from 2 UK hospitals were studied in 3 groups. Group 1: standard high definition, white light endoscopy (WLE); Group 2: WLE plus I-Scan; Group 3: non-high definition control group. The presence of endoscopic markers was recorded. At least 4 duodenal biopsies were taken from all patients. Serology was performed concurrently and observations were compared with histology. RESULTS 758 patients (62% female, mean age 52) were recruited (Group 1: 230; Group 2: 228; Group 3: 300). 135 (17.8%) new diagnoses of coeliac disease were made (21 Group 1; 24 Group 2; 89 Group 3). The sensitivity for detection of endoscopic markers of villous atrophy was significantly higher in both Group 1 (85.7%, p=0.0004) and Group 2 (75%, p=0.005) compared to non-high definition controls (41.6%). There was no significant difference between high definition only and I-Scan groups (p=0.47). In non-high definition endoscopy a missed diagnosis was associated with lesser degrees of villous atrophy (p=0.019) and low tTG titre (p=0.007). CONCLUSIONS High definition endoscopy with or without I-Scan increases the detection of celiac disease during routine endoscopy.

Office-Based Point of Care Testing (IgA/IgG-Deamidated Gliadin Peptide) for Celiac Disease

OBJECTIVES: Celiac disease (CD) is common yet under‐detected. A point of care test (POCT) may improve CD detection. We aimed to assess the diagnostic performance of an IgA/IgG‐deamidated gliadin peptide (DGP)‐based POCT for CD detection, patient acceptability, and inter‐observer variability of the POCT results. METHODS: From 2013‐2017, we prospectively recruited patients referred to secondary care with gastrointestinal symptoms, anemia and/or weight loss (group 1); and patients with self‐reported gluten sensitivity with unknown CD status (group 2). All patients had concurrent POCT, IgA‐tissue transglutaminase (IgA‐TTG), IgA‐endomysial antibodies (IgA‐EMA), total IgA levels, and duodenal biopsies. Five hundred patients completed acceptability questionnaires, and inter‐observer variability of the POCT results was compared among five clinical staff for 400 cases. RESULTS: Group 1: 1000 patients, 58.5% female, age 16‐91, median age 57. Forty‐one patients (4.1%) were diagnosed with CD. The sensitivities of the POCT, IgA‐TTG, and IgA‐EMA were 82.9, 78.1, and 70.7%; the specificities were 85.4, 96.3, and 99.8%. Group 2: 61 patients, 83% female; age 17‐73, median age 35. The POCT had 100% sensitivity and negative predictive value in detecting CD in group 2. Most patients preferred the POCT to venepuncture (90.4% vs. 2.8%). There was good inter‐observer agreement on the POCT results with a Fleiss Kappa coefficient of 0.895. CONCLUSIONS: The POCT had comparable sensitivities to serology, and correctly identified all CD cases in a gluten sensitive cohort. However, its low specificity may increase unnecessary investigations. Despite its advantage of convenience and rapid results, it may not add significant value to case finding in an office‐based setting.

OC-040 A pre-endoscopy point of care test (iga/igg-deamidated gliadin peptide) as a case finding tool for coeliac diseasein secondary care

Introduction Coeliac disease (CD) is common yet underdiagnosed. 12.4% CD patients had a gastroscopy within 5 years without duodenal biopsies taken, and coeliac serology was performed in only 30% of patients with anaemia or suspected CD. A pre-endoscopy point of care test (POCT) could potentially fill this gap. We aimed to evaluate the diagnostic accuracy and acceptability of the POCT, Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland), in detecting CD. Method Group 1: Patients attending for a gastroscopy were prospectively recruited from 2013–17. We excluded patients with a high pre-test probability of CD: positive endomysial antibody (EMA) referrals, previous villous atrophy, self-reported gluten sensitivity, those on a gluten free diet (GFD), suspected gluten ataxia; and known CD. Group 2: Patients who self-reported gluten sensitivity were prospectively recruited. All patients underwent the POCT, tissue transglutaminase antibodies (TTG), EMA and duodenal biopsies. The sensitivities of the POCT were compared to TTG and EMA, measuring against histology as the reference standard. Questionnaires regarding patient preference to the modality of antibody testing were given out. Results Group 1: 1000 patients were recruited (585 females, 58.5%; age range 16–91, median age 57). Forty-one patients (4.1%) were diagnosed with CD. Group 1: Abstract OC-040 Table 1 Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 82.9 (67.9–92.9) 85.4 (83.0–87.6) 19.5 (16.5–23.0) 99.2 (98.4–99.6) TTG 78.1 (62.4–89.4) 96.3 (94.8–97.4) 47.1 (38.3–56.0) 99.0 (98.3–99.5) EMA 70.7 (54.5–83.9) 99.8 (99.3–100.0) 93.6 (78.2–98.3) 98.8 (98.0–99.2) Group 2: Seventy patients who self-reported gluten sensitivity were recruited (51 females, 82.9%; age range 17–73, median age 35). Nine patients on a self-imposed GFD were excluded. Of the remaining 61 patients, 42 (68.9%) were diagnosed with non-coeliac gluten sensitivity (NCGS), 17 (27.9%) with CD and 2 (3.3%) with potential CD. Group 2: Abstract OC-040 Table 2 Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 100 (82.4–100) 81.0 (65.9–91.4) 70.4 (56.0–81.6) 100 TTG 89.5 (66.9–98.7) 97.6 (87.4–99.9) 94.4 (70.9–99.2) 95.4 (84.7–98.7) EMA 84.2 (60.4–96.6) 97.6 (87.4–99.9) 94.1 (69.6–99.1) 93.2 (82.9–97.5) Five hundred patients responded to the POCT acceptability questionnaire. 90.8% preferred a POCT, 2.8% preferred venepuncture, and 6.8% had no preference. Conclusion The POCT had comparable diagnostic performance to conventional serology. It also correctly identified all cases of CD in a gluten sensitive cohort. The POCT could serve as a valuable and convenient case finding tool, with the advantage of providing antibody results rapidly at the point of endoscopy to target duodenal biopsy sampling for those with a positive POCT. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Rees: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, D. Sanders Conflict with: Professor Sanders has received educational research grants from Dr Schaer (a gluten-free food manufacturer) and Tillotts Pharma (producer of a point of care test for celiac disease) for investigator led studies. Dr Shaer and Tillott’s Pharma did not have any input in the study design, access to study data, interpretation of the findings or drafting of the manuscript.

OC-018 The role of a point of care test (iga/igg-deamidated gliadin peptide) in predicting histological remission in coeliac disease on a gluten free diet

Introduction Coeliac disease (CD) is a chronic inflammatory enteropathy treated with a gluten free diet (GFD). Non adherence can lead to symptoms and complications such as osteoporosis and malabsorption. Moreover, patients with persistent villous atrophy are twice as likely to develop lymphoproliferative malignancies compared to those who achieve mucosal healing. Therefore, the optimal assessment of treatment response is the evaluation of duodenal histology. However, there is little consensus in the UK on routine follow up biopsy. Duodenal biopsy requires a gastroscopy which is invasive and can be poorly tolerated. There is currently no reliable surrogate marker for histological remission in our daily clinical practice. We aimed to assess the role of a finger prick point of care test (POCT), Simtomax (IgA/IgG-deamidated gliadin peptide, Tillotts Pharma, Rheinfelden, Switzerland), in predicting histological remission in CD. Method We prospectively recruited patients with known CD attending for a gastroscopy with duodenal biopsy for the assessment of histological remission. IgA-endomysial antibodies (EMA), IgA-tissue transglutaminase antibodies (TTG), total IgA levels and the POCT were performed in all patients at endoscopy. Patients also completed a validated GFD adherence questionnaire devised by Biagi et al. which gives a 5 point score (0–4), with the highest score indicating strict dietary adherence. A gastroscopy was performed with quadrantic biopsies taken from the second part of the duodenum and one from the duodenal bulb. We compared all surrogate markers to the gold standard of duodenal histology. Sensitivity (%) Specificity (%) PPV (%) NPV (%) POCT 67.1 (56.0–76.9) 59.1 (50.2–67.6) 51.4 (45.0–57.6) 73.6 (66.6–79.6) TTG 44.7 (33.9–55.9) 86.4 (79.3–91.7) 67.9 (56.4–77.5) 70.8 (66.5–74.8) EMA 37.7 (27.4–48.8) 89.4 (82.9–94.1) 69.6 (56.5–80.1) 69.0 (65.1–72.6) Adherence score 24.7 (16.0–35.3) 86.4 (79.3–91.7) 53.9 (39.8–67.3) 64.0 (60.8–67.2) Results A total of 217 (70% female, age range 16–83, median age 53) patients with CD on a GFD (median duration 6 years) were recruited from 2013–2017. Eighty-five (39.2%) patients had persistent villous atrophy. The POCT was the most sensitive surrogate marker for predicting villous atrophy (p=0.0005). Conclusion Of all clinically available surrogate markers, the POCT was the most sensitive in predicting villous atrophy. The POCT has the additional advantage of convenience being a finger prick test, providing rapid results within 10 min. In combination with clinical and dietetic assessments, the POCT could aid clinical decision making on the necessity of follow-up duodenal biopsy within the same consultation. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Rees: None Declared, M. Burden: None Declared, S. Wong: None Declared, D. Sanders Conflict with: Professor Sanders has received educational research grants from Dr Schaer (a gluten-free food manufacturer) and Tillotts Pharma (producer of a point of care test for celiac disease) for investigator led studies. Dr Shaer and Tillott’s Pharma did not have any input in the study design, access to study data, interpretation of the findings or drafting of the manuscript.

OC-028 Does Duodenal Histology Yield any Other Diagnoses for Iron Deficiency Anaemia Apart From Coeliac Disease?

Introduction The prevalence of iron deficiency anaemia (IDA) is 2–5% in the developed world. The BSG IDA guidelines recommend screening for coeliac disease (CD) with serology, and those tested positive should undergo duodenal biopsy to assess for villous atrophy (VA). The availability of pre-endoscopy serology in IDA has been shown to be 30%, thus often committing clinicians to routinely biopsy the duodenum. We aimed to explore whether any causes other than CD would be found on duodenal biopsy in IDA. We also aimed to evaluate the role of Simtomax, an IgA/G-deamidated gliadin peptide based point of care test (POCT), in detecting CD in IDA in the endoscopy setting. Methods Group 1: we retrospectively reviewed the duodenal histology of 153 patients with IDA attending a non coeliac specialised IDA clinic in 2013–14. Group 2: we prospectively recruited 133 patients with iron deficiency attending for a gastroscopy to our research gastroscopy list. All patients undertook Simtomax, endomysial antibodies (EMA), tissue transglutaminase (TTG), total IgA, and 5 duodenal biopsies. The results were compared against histology. Results The duodenal histology in group 1 yielded no cause for the IDA apart from CD. Two patients had VA- 1 with positive serology and hence was diagnosed with CD; the other patient never had a serology to confirm the diagnosis as he subsequently died from colon cancer. Assuming the latter case to be CD, the prevalence of CD in this cohort would be 1.3%. 5/7 patients with lymphocytic duodenosis (LD) had a cause for or association with LD: vitiligo, autoimmune hypothyroidism, aspirin use, proton pump inhibitor use, and Helicobacter pylori infection respectively. No attributable causes for LD were found in the remaining 2 patients. In group 2, the prevalence of CD was 19.5%. The sensitivity and NPV of Simtomax were 100%.Abstract OC-028 Table 1 Gp1 Histology 153 Normal (Marsh 0) 141 (92.2%) LD (Marsh 1) 7 (4.6%) VA (Marsh 3 c) 2 (1.3%) Reactive changes, submucosal haemangioma, chronic duodenitis 1, 1, 1 Gp2 Sensitivity, % Specificity, % PPV, % NPV, % Simtomax 100 82.2 57.8 100 TTG 96.2 91.5 73.5 99.0 EMA 84.6 99.1 95.7 96.4 Conclusion Our duodenal histology review revealed no alternative causes for the IDA other than villous atrophy secondary to CD. Simtomax had 100% sensitivity and NPV for detecting CD in IDA. This suggests that performing a duodenal biopsy in patients with a negative Simtomax test is highly unlikely to yield a diagnosis for IDA, thus could be safely avoided if the sole purpose of the biopsy is to investigate IDA. Simtomax could provide significant cost savings by targeting patients with IDA who require a duodenal biopsy. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, S. Cross: None Declared, J. Hebden: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

OC-024 Does the Point of Care Test, Simtomax, Distinguish between Coeliac Disease and Non-Coeliac Gluten Sensitivity?

Introduction Non coeliac gluten sensitivity (NCGS) is an emerging clinical entity with a prevalence of 0.5–13%. It is characterised by gluten related symptoms with a negative coeliac serology and no villous atrophy (VA). It is currently a diagnosis based on exclusion of coeliac disease (CD). We aimed to assess the role of Simtomax, an IgA/G deamidated gliadin peptide (DGP) based point of care test (POCT), in differentiating between NCGS and CD. Methods Group 1: we compared the sensitivities of 3 POCTs: Simtomax, Biocard [IgA-tissue transglutaminase (TTG)] and Celiac Quick Test (IgA/G/M-TTG). We prospectively recruited 100 patients referred with a positive endomysial antibody (EMA) attending for a gastroscopy. All patients undertook the 3 POCTs, EMA, TTG, and all underwent a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Group 2: the sensitivity of Simtomax in the general population was evaluated by prospectively recruiting 667 patients with gastrointestinal symptoms or ataxia attending for a gastroscopy. To reduce positive ascertainment bias, we excluded patients referred with a positive EMA, previous VA, known CD, self-reported gluten sensitivity, and those on a gluten free diet. All patients undertook Simtomax, EMA, TTG and a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Group 3: we demonstrated the sensitivities of Simtomax in a gluten sensitive population. 35 patients with self-reported gluten sensitivity attending for a gastroscopy were prospectively recruited. All patients undertook Simtomax, EMA, TTG and a gastroscopy with 5 duodenal biopsies. Sensitivities were measured based on their histology. Results Group 1 showed that Simtomax was the best POCT in detecting CD. The CD prevalence was 85%. In group 2, the sensitivity and negative predictive value (NPV) of Simtomax were comparable to that of EMA and TTG. The prevalence of CD was 4.95%. In group 3, Simtomax had 100% sensitivity and NPV in differentiating between CD and NCGS. 4 patients (11.4%) were diagnosed with CD, 4 (11.4%) with potential CD (positive serology but no VA) and 27 (77.1%) with NCGS (negative serology and no VA).Abstract OC-024 Table 1 Gp 1 Sensitivity, % Specificity, % PPV, % NPV, % Simtomax 96.5 6.67 85.4 25 Biocard 71.8 53.3 89.7 25.0 Celiac Quick Test 67.1 33.3 85.1 15.2 Gp 2Simtomax 78.8 85.0 21.5 98.7 EMA 72.7 99.5 88.9 98.6 TTG 75.8 93.1 36.2 98.7 Gp 3Simtomax 100 80.6 40.0 100 EMA 75.0 96.8 75.0 96.8 TTG 75.0 87.1 42.9 96.4 Conclusion Simtomax was the most accurate POCT for detecting CD. In a lower CD prevalence group 2 cohort, its sensitivity remained comparable to TTG and EMA. Simtomax had 100% sensitivity in detecting CD in patients with self-reported gluten sensitivity, and 100% NPV in identifying patients with NCGS. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

PWE-058 The Role of A Point of Care Test, Simtomax, in Predicting Histological Remission in Coeliac Disease on A Gluten Free Diet: Abstract PWE-058 Table 1

Introduction Coeliac disease (CD) is a chronic inflammatory enteropathy treated with a gluten free diet (GFD). Clinical symptoms and complications of CD are thought to be associated with ongoing duodenal inflammation due to continued gluten exposure, hence the optimal assessment of response to a GFD is histological remission. However, there is little consensus in the UK on routine re-biopsy during follow up. Duodenal biopsy requires a gastroscopy which is invasive and can be poorly tolerated. Coeliac serology and dietetic evaluation have been used as surrogate markers for histological remission, but the correlation has been shown to be poor. We aimed to assess the role of an IgA/G-deamidated gliadin peptide (DGP) based point of care test (POCT), Simtomax, in predicting histological remission in CD. Methods We prospectively recruited patients with known CD attending for a gastroscopy with duodenal biopsy for the assessment of disease remission. All patients underwent a blood test for IgA-endomysial antibodies (EMA), IgA-tissue transglutaminase antibodies (TTG), total IgA levels and Simtomax at the point of endoscopy. They also completed a validated GFD adherence questionnaire (Biagi) which gives a 5 point score (0–4), with the highest score indicating strict adherence to a GFD. Patients with an adherence score of 3 or 4 were considered to follow a strict GFD. A gastroscopy was then performed with quadrantic biopsies taken from the second part of the duodenum and one biopsy taken from the duodenal bulb. We compared all surrogate markers to the gold standard of duodenal histology. Results 145 (74% female, median age 53) patients with CD on a GFD were recruited from 2013–2015. 52 (36%) patients had persistent villous atrophy. Simtomax was the most sensitive in predicting villous atrophy (78.8%). The sensitivities of EMA, TTG and the GFD adherence score were significantly lower than that of Simtomax. Simtomax had the best negative predictive value (NPV) for villous atrophy at 82.5%.Abstract PWE-058 Table 1 Surrogate marker Sensitivity (%) Specificity (%) PPV (%) NPV (%) Simtomax 78.8 (78.5–79.2) 55.9 (55.6–56.2) 50 (49.7–50.3) 82.5 (82.2–82.8) TTG 51.9 (51.5–52.4) 80.6 (80.4–80.9) 60 (59.5–60.5) 75 (74.7–75.2) EMA 36.5 (36.1–37.0) 83.9 (83.6–84.1) 55.9 (55.3–56.4) 70.3 (70.0–70.5) Adherence score 23.1 (22.7–23.4) 82.8 (82.6–83.0) 42.9 (42.3–43.4) 65.8 (65.5–66.1) Conclusion Simtomax exceeds all other available surrogate markers in predicting the presence of villous atrophy. Simtomax could be used to aid informed decision making in patients who require but are reluctant to undertake a gastroscopy for duodenal biopsy to assess for disease remission. It could also act as a useful adjunct to identify patients who may require further dietetic support. Disclosure of Interest M. Lau: None Declared, P. Mooney: None Declared, W. White: None Declared, M. Burden: None Declared, S. Wong: None Declared, M. Kurien: None Declared, D. Sanders Grant/research support from: Tillotts Pharma for investigator led studies in coeliac disease. None of the funding sources had any input in the study design, access to study data, interpretation of the findings or drafting of the abstract.

PTH-176 Predicting histological remission in patients with coeliac disease on a gluten free diet: Abstract PTH-176 Table 1

Introduction Up to 30% of patients with celiac disease (CD) will have persistent symptoms despite the introduction of a gluten free diet (GFD). Assessment of adherence in celiac disease can involve any combination of patient self-reporting adherence, dietetic assessment, serology and biopsy with histology. Histology is considered to be the ‘gold standard’ but this requires a repeat endoscopic examination with its associated risks and problems with tolerance. As a result surrogate markers of persistent gluten exposure and histological changes such as serology are frequently used but the relationship between serology and persistent histological changes is not linear. A structured interview with a dietician has been shown to be the most accurate method of assessing GFD adherence however this is time consuming and requires extra clinic visits. The aim of this study was to assess the usefulness of two novel options. Firstly a previously internally validated scoring system for assessing GFD adherence (which has never been externally validated) and secondly a rapid deamidated gliadin peptide based point of care test (POCT, Simtomax) for the prediction of persistent villous atrophy (VA). Method All patients with known CD and persistent symptoms coming to a specialist CD endoscopy list for the re-assessment of histology were invited to take part. All patients were tested for Endomysial Antibody (EMA), tissue transglutaminase (tTG), immunoglobulins and the POCT. They were also asked to complete a questionnaire to calculate a 5 point score (0–4) with a high score representative of improved adherence to a gluten free diet. All patients underwent gastroscopy with at least 4 biopsies from the second part of the duodenum and 1 to 2 biopsies from the bulb. Results 94 patients (77% female, mean age 52.6) were recruited between April 2013 and December 2014. Median duration of GFD was 84 months (range 6–768). 36 (38.3%) patients had persistent VA on duodenal biopsy. The POCT was the most sensitive marker with 63.4% of patients with VA having a positive test. EMA was the most specific surrogate marker at 82.8% although it was highly insensitive with only 33.0% of patients with VA having a positive EMA. The adherence score could not be reliably used to predict VA with a sensitivity of only 30.6%. Conclusion An accurate surrogate marker for VA could reduce the number of endoscopies required. In this cohort the POCT had the best sensitivity, detecting 23/36 (63.4%) cases of villous atrophy, however this is pilot data and further work is required. It may be that additive methods for assessing adherence could achieve 100% sensitivity.Abstract PTH-176 Table 1 Measure Sensitivity (%) Specificity (%) PPV (%) NPV (%) Adherence Score 30.6 79.3 47.8 64.8 tTG 50.0 75.9 56.3 37.9 EMA 33.0 82.8 54.5 66.7 POCT 63.4 60.3 50.0 72.9 Disclosure of interest P. Mooney: None Declared, S. Wong: None Declared, M. Kurien: None Declared, M. Burden: None Declared, D. Sanders Grant/ Research Support from: Received research grants from BHR Pharmaceuticals and Tillotts Pharma for investigator led studies into coeliac disease.

PWE-030 High definition (hd) endoscopy but not i-scan significantly increases the detection of markers of coeliac disease: a multicentre uk study

Introduction Coeliac disease (CD) remains underdiagnosed. Many patients with CD have undergone a previous endoscopy where the opportunity to make a diagnosis was missed. Clinicians may rely on endoscopic markers of CD to guide biopsy but they lack sensitivity. A routine duodenal biopsy approach may solve this problem but it is expensive. Methods to improve the detection of CD at endoscopy to guide biopsy would seem advantageous. I-Scan, a digital enhancement technique, has shown promising results. However, only one, single centre study has been performed. This was an uncontrolled, unblinded trial in high prevalence population (35% CD). We aimed to assess the utility of I-Scan in a lower prevalence population in a randomised controlled trial Method Patients from 2 UK hospitals (Royal Hallamshire Hospital, Sheffield and St. Mary’s Hospital, London) were randomised into 2 groups: Group 1 standard HD white light endoscopy (WLE) and Group 2 WLE plus I-Scan. Patients were compared to a standard non-HD WLE control group, Group 3. All patients received at least 4 duodenal biopsies. Coeliac serology was performed concurrently. The presence of endoscopic markers of CD, scalloping, mosaic pattern, nodularity, loss of duodenal folds or increased vascularity was noted and compared to VA on histology as the gold standard Results 700 patients (63% female, mean age 51.7) were recruited (201 into Group 1, 199 in Group 2 and 300 into Group 3). In total 130 (18.5%) new diagnoses of CD were made (19 in Group 1, 22 in Group 2 and 89 in Group 3). In new CD cases, endoscopic markers of CD were seen in 80.5% in the HD groups compared to 41.6% in Group 3 (p < 0.0001). In Group 2, I-Scan appeared to enhance changes in 18% of new CD cases. However there was no significant difference in sensitivity between Group 1 (89.5%) and Group 2 (72.7%) (p = 0.2). Full sensitivity and specificity analysis is shown in Table 1. The severity of VA was analysed for missed cases. There was no significant difference in the distribution of VA severity across the 3 groups (p = 0.6). The use of HD/I-Scan did not prevent total VA being missedAbstract PWE-030 Table 1 Analysis of the 3 interventions Sensitivity Specificity PPV NPV Group 1 89.5 (65.5–98.2) 92.9 (87.8–96.0) 56.7 (37.7–74.0) 98.8 (95.4–99.8) Group 2 72.7 (49.6–88.4) 84.8 (78.5–89.6) 37.2 (23.4–53.3) 96.2 (91.5–98.4) Group 3 41.6 (31.4–52.5) 98.1 (94.9–99.4) 90.2 (75.9–96.8) 79.9 (74.4–84.5) Conclusion HD endoscopy significantly increases the detection of the endoscopic markers of CD (p < 0.0001). However although I-scan appears to enhance the changes of villous atrophy it does not significantly increase the detection of markers (p = 0.2) Disclosure of interest None Declared.

PTU-159 Comparison of three commercially available point of care tests for coeliac disease: Abstract PTU-159 Table 1

Introduction Coeliac disease (CD) remains underdiagnosed. A rapid point of care test (POCT) may increase uptake of serological testing in appropriate patient groups. 3 POCTs are commercially available in the UK and in continental European pharmacy outlets: Biocard an IgA tissue tranglutaminase (tTG) test (BHR pharmaceuticals); Celiac Quick Test (Biohit Healthcare) detecting IgA, IgG and IgM tTG and Simtomax (Tillotts Pharma) which detects IgA and IgG antibodies against deamidated gliadin peptides (DGP). A fourth POCT has also been developed but not marketed (Xeliac Test Pro, Personal Diagnostics), with availability being solely from the manufacturer and no published data existing supporting its validity. Of the 3 commercially available POCTs, there is a limited evidence base with significant ascertainment bias. For this reason we decided to compare 3 commercially available tests in an endoscopic setting. Method Patients referred with a positive endomysial antibody (EMA) for duodenal biopsy to confirm CD were recruited. All patients had repeat serum EMA, tTG and immunoglobulins and were tested simultaneously with the 3 POCTs as per the manufacturers’ instructions. All patients had quadrantic duodenal biopsies from the second part of the duodenum as well as a duodenal bulb biopsy. Demonstration of villous atrophy (VA) was required to diagnose CD. Results 82 patients (51.2% female, mean age 41.0) have been recruited. In 10 patients the EMA had normalised on repeat testing. None of these patients had VA on duodenal biopsy. 9 of these patients were referred with a weak EMA and had a negative tTG. One patient had a tTG of 10 times the upper limit of normal, and subsequent gluten challenge revealed a positive EMA and VA. Of the remaining 72 patients 59 new cases of CD were confirmed with the presence of villous atrophy, of the 13 EMA positive patients without VA 8 had Marsh 1 or 2 changes present with the remaining 5 patients having normal histology. Full sensitivity, specificity PPV and NPV for all of the tests compared to VA on duodenal biopsy are shown in Table 1.Abstract PTU-159 Table 1 Test Sensitivity (%) Specificity (%) PPV (%) NPV (%) Serum tTG 98.3 (89.7–99.9) 34.8 (17.2–57.2) 79.5 (68.1–87.7) 88.9 (50.7–99.4) Biocard 72.9 (59.5–83.3) 65.2 (42.8–82.8) 84.3 (70.9–92.5) 48.4 (30.6–66.6) Celiac Quick Test 71.2 (57.7–81.9) 52.2 (31.1–72.6) 79.2 (65.5–88.7) 41.4 (24.1–60.9) Simtomax 96.6 (87.3–99.4) 30.4 (14.1–53.0) 78.1 (66.6–86.6) 77.8 (40.2–96.1) Conclusion In this pilot data set Simtomax appears to be the most sensitive of the POCTs when compared to histology with similar results to serum tTG as screening test. Further work is required in larger cohorts and lower prevalence populations to confirm the utility of these tests in adult CD. Disclosure of interest P. Mooney: None Declared, S. Wong: None Declared, M. Burden: None Declared, M. Kurien: None Declared, M. Hadjivassiliou: None Declared, D. Sanders Grant/ Research Support from: BHR pharmaceuticals; Tillotts Pharma for investigator led studies.